Care Plans in clinical practice....to "real nurses" are you using them?

nurseygrrl, LPN · May 12, 2005

I work in an SNF and we definitely use our care plans! Even if you don't use them in the sense of writing them out and having them on the chart, it is very helpful in your thought process when you admit a new patient and have to assess their needs. Care plans CYA!! Half of my unit is psych and we use them most on our psych patients. We have one man who is very resistive to care at times and becomes violent if pressed. He has a care plan on his chart for Potential For Agressive Behavior. Our care plan outlines exactly what you do to get him to comply with care while keeping staff safe. It is essential if there are float staff on the floor who dont know the patient. Care plans are definitely not a waste of time!!

pricklypear · May 12, 2005

I agree! Everybody hates doing huge care plans in school - and none of us ever see the value while we're doing them. It's true, they absolutely do shape your thought processes in the long run. Believe me. You do enough of them, and next thing you know you're working - get a patient and all these interventions pop up in your head automatically!!

Our hospital recently switched to handwritten "plan of care " type things. We had preprinted care plans before which all we did was initial. Now we're all scrambling to remember how to write one!! The new nurses are blowing us away. So, yes they do get used in clinical practice - in one way or another.

suzanne4, RN · May 12, 2005

JCAHO actually mandates that there be use of a careplan with daily documentation on it.. :)

**canoehead, BSN, RN** · May 12, 2005

We have them and document on them but we don't actually use them. they are there only to satisfy various regulating agencies. We Do actually use a Kardex that tells us what is different about this patient from the average person with pneumonia (for example). The regulating agencies don't seem to take into account that we all know the basic interventions for pneumonia, and the "care plan" should tell us what is special about each individual patient in order to be useful.

cardiacRN2006, ADN, RN · May 12, 2005

The nurses at my hospital asked me the other day if they are still using care plans, because they have not seen them since they were in nursing school! I think that Nursing diagnoses are dumb and the whole thing is a waste of my time. We use something similiar which is a clinical pathway. It is preprinted, and all you do is check off the action that you have done. This is what the nurses use as charting. So for a CABG, it will have 5 pages for 5 days, and you check off the time that you ambulated the pt, bathed, CXR done, etc... It is a combination of the assessment form and the "care plan".

nursemike, ASN, RN · May 12, 2005

Okay, so this is not cheating...honest!

The hospital where I did a lot of my clinicals used a problem sheet on the bedside chart, where the staff nurses checked off any special needs the pt might have. So, when pre-planning, I sometimes looked at the problem sheet for ideas about Nsg Dx for my careplan. I mean, you're supposed to use available resources, and if the "real" nurses see a problem with skin integrity, there's a Dx right there. Of course, you still have to think: what priority, what goals, interventions. But when you're as befuddled as I often seemed to be, any hint is helpful.

(I put "real" in quotation marks because I promised my instructor I wouldn't say that any more--student nurses are real, too. It's a real moment when you realize that we can make a real difference, even as students. Makes you really want to make it a good difference.)